For a long time, the ability of robots to interact with humans in our daily lives was more myth than reality— and the idea of robotics performing exceptionally complex tasks such as neurosurgery seemed like science fiction. However, in the mid-1980s computer technology started to catch up with design engineering, and the field of robotics began to truly evolve. The PUMA 560 (Programmable Universal Machine for Assembly or Programmable Universal Manipulation Arm), a standard industrial robotic arm, was initially developed by an engineer at Unimation, which became a subsidiary of Westinghouse Corp.
In 1985, Dr. Yik San Kwoh of Memorial Medical Center, Long Beach, CA, who developed a computer program that makes the arm work, shattered previous conceptions about robot-assisted surgery by successfully placing a needle for a human brain biopsy using Computed Tomography (CT) for guidance. This success effectively launched the “Age of Medical Robotics” around the world. The past 35 years have seen an explosion in the industry, with a global forecast of $11.4 billion by the year 2020.
A Brief History
The successful implementation of the PUMA 560 led to the development of the PROBOT at the Imperial College, London, UK, where, in 1992, Dr. Senthil Nathan completed the first entirely robotic surgery in history. Across the pond in Sacramento, CA, Integrated Surgical Supplies was already in the process of developing ROBODOC, a robot designed to mill out precise cavities in the femur, which would insert fittings during hip replacement surgery.
ROBODOC became the first robot to assist in a Total Hip Arthroplasty (THA) and was subsequently cleared by the FDA for wide use in THA surgeries. Today, the ROBODOC is still the only active robotic platform approved by the FDA for use in orthopedic surgery. These breakthroughs were closely watched by US military and NASA, who then funded private research companies to further investigate the capabilities of robots in the field. Telesurgery, the ability for a doctor to perform remote surgery, spurred several NASA scientists to join the Stanford Research Institute (SRI) with the goal to utilize virtual reality to develop a manipulator that could be used by a surgeon to operate from across a room.
The U.S. Army also had an interest in telesurgery for its potential to lower wartime casualties by bringing a virtual surgeon to an injured soldier who may be located on the battlefield. In 2005, DARPA, the Defense Advanced Research Projects Agency, envisioned and funded research that would allow an injured soldier to be loaded onto a vehicle or pod where a surgeon, located in a safe location, could use telepresence to make real-time medical decisions until the soldier could reach proper medical attention. Individuals working on the NASASRI team later formed commercial projects understanding the value of the emerging robotic market, and in 1995, Dr. Frederic H. Moll acquired the license to the NASA-SRI telepresence surgical system and started Intuitive Surgical Inc.
Today’s Surgical Robots
The most technologically advanced surgical robot in operation today is the da Vinci Surgical System by Intuitive Surgical Inc., Sunnyvale, CA. The system consists of three main components that work together seamlessly during surgical procedures: the Vision System, which includes a high-definition 3D endoscope and a large viewing monitor: the Patientside Cart that contains three or four robotic arms that carry out the surgeon’s commands; and the Surgeon Console, where the surgeon utilizes 3D imagery from the endoscope, as well as hand manipulators with Endowrist instruments (which provide seven degrees of motion, more than a human wrist) to perform the surgery. (See Figure 1)
In 2000, the da Vinci system became the first robotic surgical system to be cleared by the FDA for general laparoscopic (abdominal) surgery. The da Vinci’s capabilities continued to evolve, and the FDA certified the robot for use in thoracoscopic (chest) procedures, as well as laparascopic removal of the prostate and a variety of urologic, gynecologic, pediatric, and otolaryngology approvals followed.
The technology used to develop these systems has grown exponentially since its introduction in 1985. A great example of merging robotics and motion control can be found in the neuroArm, developed in 2007 by a team led by Dr. Garnette Sutherland, Professor of Neurosurgery, University of Calgary. (See Figure 2) The neuroArm, a Magnetic Resonance Imaging (MRI)-compatible image-guided computer-assisted surgical robot designed for neurosurgery, was funded by the Canada Foundation for Innovation, Western Economic Diversification, Alberta Advanced Education and Technology and the philanthropic community of Calgary.
In 2008, this surgical system made history by performing the first brain surgery to remove a tumor through the use of its MRI-compatible robotics as well as an intraoperative MRI. The combined use of these technologies allows an MRI scanner to move into the operating room, providing in-depth imaging during the actual procedure without having to stop the surgery to review scans as before.
Previously, combining these technologies was not thought to be feasible as the magnetic field produced by the MRI equipment is in the range of 1.5 to 3 Tesla or 15,000 to 30,000 gauss (for reference the Earth’s magnetic field is only 0.50 gauss). This means anything metallic inside of this field could potentially become a dangerous projectile as well as produce artifacts on any images the doctor would use to make critical surgical decisions.
To address this issue, Dr. Sutherland worked closely with engineering group who, in turn, succeeded in customizing a solution. They were able to modify motors specifically designed for use in a vacuum environment for semiconductor manufacturing by substituting ceramic parts, where stainless was previously used, and adding ceramic bearings. Using piezoelectric ceramic in the specialized motors allows motion to be created strictly through friction and filters to ensure the digital signal of the motors did not interfere with the MRI scanner.